A ‘Losing Prospect’ Argument for Changing Sanitation Behaviour

Fact #1: One in six people still defecate in the open.
Fact #2: Most of them are not entirely convinced that a toilet does any good.
Fact #3: Many of the recent toilet adopters still like to go in the open.

I don’t mean to be alarmist, but these signal a need for a shift in thinking about the complex problem of addressing behaviour change with respect to toilet adoption.

With a myriad missing links to sustainable sanitation uptake, I’ll stick my neck out and say that the stickiest issue in sanitation today is not one of lack of investment, nor political commitment or markets. Clearly, the governments understand the wide-ranging impacts of sanitation on health, environment, and economy, and have committed billions of dollars to increasing sanitation coverage. Recently, the Government of India quadrupled its investment in rural sanitation in the current planning period (2012 – 2017) to US$ 6 billion[1] through its ambitious Nirmal Bharat Abhiyanprogram. Moreover, there seems to be robust enthusiasm in the private sector for the ‘ready for take-off’ sanitation market in low-and-middle income countries with low coverage. The continually baffling dilemma is in some ways an age-old one – that of changing mindsets. How do we influence and change the entrenched behaviour of open defecation and create a compelling case for toilet use? What is the appropriate rationale for applying social and behavioural interventions to get people not just to build toilets but also to use them?

Behavioural economics’ Prospect Theory that models real-world decisions as opposed to optimal decisions might have an answer. The theory posits that people hate losing much more than they like winning (loss aversion), and that the value function for potential losses is much steeper than that for gains (Figure 1). Further, people make decisions based on the potential value of gains and losses rather than the final outcome. This implies that they tend to take a more intense view of losses than gains, even when in effect they arrive at the same final outcome. Therefore, the reference point or the ‘frame’ matters.

Now let’s attempt to apply the theory to the problem of sanitation demand and uptake. The current approach to community-led total sanitation emphasizes creating what behavioural economists would call a ‘gain prospect’ for potential adopters. The logic flows somewhat like this: “You should not defecate in the open, and build and use a toilet because it produces health, convenience, privacy, dignity and safety benefits for you and your community.” The problem with this approach is that potential gains are valued much less than losses, not to mention that health benefits in particular are too far out in the future to influence a significant change in behaviour. It is hard for the consumers to grapple with long-term beneficial impacts of sanitation. Then, of course there is inertia to having done things a certain way.

Still staying with the Prospect Theory, the perceived value of toilet use might be increased at least two-fold[2] by presenting the normative practices of open defecation and not using the toilet as losing propositions. The ‘loss prospect’ argues: “You stand to lose immensely by defecating in the open and not using your toilet. There are grave losses in terms of health, privacy, safety and convenience for you and your community. Ergo, you should not defecate in the open and build and use toilets.” This shift in frame from gain utility of sanitation to loss utility of open defecation would likely have a stronger psychological draw for delivering impact on the intractable issue of behaviour change.

It is widely agreed that one of the main missing links in driving real demand for sanitation is the poor traction we have on behaviour change. It not only undermines huge investments but also thwarts excellent policy. Stepping outside the box to apply the insights of psychology to implementing behaviour change is an experiment worth trying. Professor Kahneman would agree!

Even so, it is hardly surprising since the success of CLTS is largely premised on a collectivist understanding and resolution of the open defecation problem, a philosophically individualist argument (one that argues gain) to achieve sanitation behaviour change is in some ways set to fail. The loss argument also has a solidarity effect in that it would likely have a stronger impact in spurring communities to action.

Efforts for stopping open defecation are not keeping the full problem in their scope, hence are failing. A full picture is provided here -
http://articles-and-essays.blogspot.in/2012/12/desirability-of-open-defecation-in.html

Interesting piece, and I agree that anything's worth a shot - and this seems sensible. However, I'm not clear on what's exactly the perceived (or real) 'loss' around switching away from open defecation. I know it represents a change from what's normal behaviour, but nothing material, or 'tangible' is being taken away or lost? And, lastly, would what you're proposing require fundamental changes in the way CLTS is practiced? Thanks, Gavin Collins (The Transforming Waste Project - www.transformingwasteproject.com)

The behavior change angle is definitely important and it is my view that we have to approach this with a "menu of options" rather than one theory to test. Pooling of ideas and having people experiment with different "nudges" would be key. Some will take up this idea as an aspirational thing, some others as prevention of a bad thing. It is important to test, learn and retest..the problem is complex and has been there for many years. Unlikely we will find a solution with one tablet..

More than policy initiatives…
Most of us have not understood the real loss of unsustainable practice. Since this article is based on the research in India, I would like to add that the problem of sanitation existed even during colonial period. Sad part is even with years of independence and development, we are still discussing about sanitation. We have to really analyse the behavioural aspects of the issue. It may not be the problem of governance and investment but how we have approached the issue is important. Policy alone cannot bring necessary change when implementation do not satisfy the requirement of people.

Thanks for the interesting article. It makes sense people are more averse to losses than interested in gains, but how does this fit with the narrative that positive messages around improved status, aesthetics, convenience, etc are more motivating than messages about poor health?

CLTS is often (usually?) already formulated as a 'loss prospect', as in if you open defecate you will suffer shame, loss of dignity, health care costs etc (while not a change from the status quo - it is changing the perception of the status quo).

The 'loss prospect' in the article is in fact recognition of the previously underappreciated status quo - this may not be as powerful as the losses already exist whereas gains still stand to be made?

To my mind, the effectiveness of positive messages around status, convenience and aesthetics has more to do with the 'instant' nature of these benefits. Getting a toilet immediately provides these benefits. Also, from a behavioural economics standpoint, a gain in the short term is valued more over a potential loss (in health) in the long term. The health argument does not resonate very much with the users because the effect is cumulative and manifests over time. The psychological draw then is for gratification in the now. More importantly, however, these positive benefits of getting a toilet do not always translate into toilet use - and a loss argument might be effective there. This also bears out that the consumers mostly see sanitation as a private good (privacy, convenience, status appeals) versus a public good (health).

It is often seen that if you focus too much on the losses, to an extreme bordering on 'highlighting indignity', it may not work. Some communities may take it negatively, and therefore may not even respond to the messages being conveyed. So, it would be good to see the background of the community and tailor the messages to suit a particular context, and particular groups within the community (e.g., old vs young).

Many WASH programs to date have based their hygiene promotion work on assumptions and guess-work about what might achieve behavior change - so naturally the results have not been that great. A behavior change programming approach that incorporates formative research to discover the key determinants for behavior change (for the priority group in their particular setting will help provide some of the missing evidence essential for design behavior change strategies that work. One such approach, applicable to multiple sectors and settings is the Designing for Behavior Change Framework - see http://www.coregroup.org/resources/core-tools and http://www.coregroup.org/our-technical-work/working-groups/social-and-behavior-change

What are the losses for a person who openly defecates? And how can they be reduced (i.e. made less scary or bothersome)?

I suggest these losses - and ideas to address them:
- view of the stream or field - provide windows or similar view
- cool breeze as one defecates - provide ventilation in toilets
- socialization with friends - bring peer pressure, by those in same part of village by similar age and peer group, that they will not visit in this manner
- acceptance by community members, that this is "normal" - increase stigma associated with OD, so that it becomes more abnormal and closer to shame
- malnutrition or lack of food continues - while others are harvesting larger vegetables & fruit (a new "loss").

But those are my ideas as a Westerner. Perhaps we should ask the people in the village (who are persuaded to be ODF) how can _they_ address perceived losses by those who are not ODF? It's their community.